Provider Demographics
NPI:1760922678
Name:ORTEGA, CARISSA RHEA (MSN, APRN, CPNP-AC/P)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:RHEA
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:MSN, APRN, CPNP-AC/P
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:DECLERCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 CHILDRENS AVE # 2F
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4637
Mailing Address - Country:US
Mailing Address - Phone:405-271-4411
Mailing Address - Fax:
Practice Address - Street 1:1200 CHILDRENS AVE STE 2F
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4637
Practice Address - Country:US
Practice Address - Phone:405-271-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK94568363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200700860BMedicaid